Saturday, October 31, 2015

More children than ever before are being
diagnosed with autism spectrum disorder (ASD). The dramatic increase in the
prevalence of children with ASD has created an urgent need
for effective and efficient service delivery models. Parents and caregivers
everywhere are eager for credible, research-based information on the most
effective treatments for ASD. Utilizing a group training format, researchers
have found that parents can learn to successfully incorporate an established
treatment for ASD into everyday interactions with their children. According to
findings published in theJournal
of Child Psychology and Psychiatry, parents learned to successfully
apply an evidence-based therapy method calledPivotal Response
Treatment (PRT), also referred to as Pivotal Response Training, and
observed meaningful improvement in their children.

PRTis one of the best studied and
validated behavioral treatments for autism. It is a naturalistic behavioral
intervention derived from the principles of Applied Behavior Analysis (ABA).PRTbuilds on learner initiative and
interests, and is particularly effective for developing communication,
language, play, and social behaviors. PRT was developed to create a more
efficient and effective intervention by enhancing four pivotal learning
variables: motivation, responding to multiple cues, self-management, and
self-initiations. According to theory, these skills are pivotal because they
are the foundational skills upon which learners with ASD can make widespread
and generalized improvements in many other areas.

The objective of the study was to evaluate a
PRT parent training group (PRTG) for targeting language deficits in young
children with ASD. For the study, researchers randomly assigned parents of 53
children with autism to participate in 12 weeks of classes on PRT or a
psychoeducation group (PEG). All of the children were between the ages of 2 and
6 and had language delays. The PRTG taught parents behavioral techniques to
facilitate language development. The PEG taught general information about ASD.
All of the children were assessed at the outset of the study, at six weeks and
at 12 weeks to determine their language abilities. Parents were also videotaped
at six and 12 weeks to measure how well they were applying the treatment.

The results indicated that parents were able
to learn PRT in a group format, as the majority of parents in the PRTG (84%)
were using it correctly by the end of the study. Children also demonstrated
improvement in adaptive communication skills. Children whose parents learned
the technique reported greater gains in both the number of words used and how
they used them as compared to children in the psychoeducation (control) group.

This study is considered the first randomized
controlled test of group-delivered PRT and one of the largest experimental
investigations of the PRT model to date. The findings suggest that specific
instruction in PRT results in greater skill acquisition for both parents and
children, especially in functional and adaptive communication skills. Even with
the improvements, researchers said that parent-implemented approaches are
intended to augment, not replace, autism therapies from professionals. Likewise,
further research in PRT is warranted to replicate the observed results and
address other core ASD symptoms. It should also be noted that research findings
are not the only factor involved when selecting an intervention. Professional
judgment and the values and preferences of parents, caregivers, and the
individual are also important.

Tuesday, October 27, 2015

Younger siblings of
children with autism spectrum disorder (ASD) are at high risk for developing
ASD as well as features of the broader autism phenotype. About 20% of younger
siblings of children with Autism Spectrum Disorder (ASD) will develop the
condition by age 3. Astudy
by Yale School of Medicine researchers has found that 57% of these younger
siblings who later develop the condition already showed warning signs like poor
eye contact and repetitive behaviors at just a year and a half old. Published
in the Journal
of the American Academy of Child & Adolescent Psychiatry, this is
the first large-scale, multi-site study aimed at identifying specific
social-communicative behaviors that distinguish infants with ASD from their
typically and atypically developing high-risk peers as early as 18 months of
age. For the study, researchers looked at data on 719 infants who had older
siblings on the spectrum. The children were assessed at 18 months and again at
36 months to identify social, communication and repetitive behaviors that could
be predictive of autism.

Three distinct
combinations of features at 18 months were predictive of ASD outcome: 1) poor
eye contact combined with lack of communicative gestures and giving; 2) poor
eye contact combined with a lack of imaginative play; and 3) lack of giving and
presence of repetitive behaviors, but with intact eye contact. These 18-month
behavioral profiles predicted ASD versus non-ASD status at 36 months with 82.7%
accuracy in an initial test sample and 77.3% accuracy in a validation sample.
Clinical features at age 3 among children with ASD varied as a function of
their 18-month symptom profiles. Children with ASD who were misclassified at 18
months were higher functioning, and their autism symptoms increased between 18
and 36 months.

"While the majority
of siblings of children with ASD will not develop the condition themselves, for
those who do, one of the key priorities is finding more effective ways of
identifying and treating them as early as possible," said lead author
Katarzyna Chawarska, associate professor in the Yale Child Study Center and the
Department of Pediatrics at Yale School of Medicine. "Our study reinforces
the need for repeated diagnostic screening in the first three years of life to
identify individual cases of ASD as soon as behavioral symptoms are
apparent." Early detection, especially when toddlers have siblings with
autism, is critical. Chawarska added, "Linking these developmental
dynamics with underlying neurobiology may advance our understanding of causes
of ASD and further efforts to personalize treatment for ASD by tailoring it to
specific clinical profiles and their developmental dynamics."

“18-Month Predictors of
Later Outcomes in Younger Siblings of Children With Autism Spectrum Disorder: A
Baby Siblings Research Consortium Study.” Published online 06 October
2014. Journal
of the American Academy of Child & Adolescent Psychiatry.

Thursday, October 1, 2015

The increase in
the prevalence of autism spectrum conditions among children and adolescents and
the correspondingly large number of youth transitioning into adulthood has
created an urgent need to address the mental health needs, isolation, and poor quality of life faced by many adults on the
autism spectrum. Unfortunately, there are few validated treatment options are
available for adults with autism spectrum disorder (ASD). Much of the published
literature is clinical or anecdotal, or purely based on theory. There is unquestionably
a need for the development of treatment options for adults with ASD. At
present, alternative treatment options to psycho-therapeutical interventions
are social training programs and other group activities. Group settings enable
social interaction and sharing experiences with others, thereby reducing social
isolation.

Research

A study published in the peer reviewed journal Autism assessed the
effectiveness of two group interventions for adults with ASD: cognitive behavioral
therapy (CBT) and recreational activity.A
total of 68 adults with ASD participated in the study and were stratified by
gender and blindly randomized to one of the two treatment conditions. Both interventions comprised 36 weekly 3-hour sessions led by two therapists in groups of 6–8 participants. The CBT
group intervention was adapted to suit adults with ASD and consisted of five
elements: (a) structure, (b) group setting, (c) psycho-education (e.g. lectures
and discussions on ASD and psychiatric symptoms, including learning to identify
and reappraise maladaptive thoughts), (d) social training (e.g. skill building
such as practicing phone calls and asking for help) and (e) cognitive behavioral
techniques (e.g. setting goals, role-playing, exposure exercises and conducting
behavior analysis). A manual describing the 36 individual sessions was created
prior to starting the treatment. Each session followed a strict agenda: (a)
introduction and presentation of the agenda of the day, (b) review of homework
assignments from the previous session, (c) psycho-educative lecture and
discussions on the session topic, (d) coffee break with buns or sandwiches and
social interaction, (e) relaxation or mindfulness exercise, (f) discussions and
exercises on the session topic, (g) distribution of homework and (h) evaluation
and end of session.

The purpose of the
recreational activity intervention was to facilitate social interaction and to
break social isolation. The therapists did not provide any deliberate
techniques, such as psycho-education, social training, or CBT. Rather, this
intervention relied on structure and group setting only. During the first
session, participants were asked to write down group activities they would like
to engage in. The therapists created a list of the suggested activities, such
as visiting museums, playing board games, cooking, restaurant visits, boating,
cinema, and taking walks. Each week, participants voted for the next session’s
activity.

The researchers
hypothesized that both interventions would lead to improvement in primary measures
of quality of life, sense of coherence, and self-esteem, as well as in the
exploratory analysis of the secondary measures of psychiatric symptoms. A
greater effect in the CBT intervention compared to recreational activity was
also expected, due to participants in the CBT intervention receiving a wider
range of psychotherapeutic techniques. Several self-report questionnaire measures
were administered to the adults before and after the interventions: Quality of
Life Inventory (health, relationships, employment, and living conditions),
Sense of Coherence (manageability and meaningfulness in life), Rosenberg Self
Esteem Scale and an exploratory analysis on measures of psychiatric health (e.g.,
anxiety and depression). A long-term follow-up was conducted which ranged from 8 to 57 months after treatment termination.

Results

Participants in both
treatment conditions reported an increased quality of life at post-treatment,
with no significant difference between the group CBT and group recreational activity
interventions. Comorbid psychiatric symptoms, sense of coherence, and
self-esteem were not affected by either intervention. CBT resulted in less
attrition (drop out) than recreational activity. Participants who received CBT also
rated themselves as more improved at post-treatment. At follow-up, CBT
participants reported better well-being, greater understanding of their own
difficulties and improved ability to express needs, compared to participants in
the recreational activity intervention. This may reflect the recreation
activity intervention’s focus on the intervention elements of structure and
group setting, while the CBT intervention also included the elements of
psycho-education, social training and CBT techniques. As a result, participants
in CBT may have developed greater understanding of their own difficulties and
improved ability to express needs and receive support because the objective of
psycho-education and social training is to enhance these capabilities. The difference
in well-being scores at follow-up may also represent greater insight gained
from CBT rather than recreational activity.

Implications

Both interventions appear
to be promising treatment options for adults with ASD, as they appeared to
improve the participants’ quality of life. The similar efficacy of the
interventions may be due to the common elements of structure and group setting.
The group setting of both interventions enabled social interaction and sharing
experiences. This may have promoted participants’ self-acceptance by allowing
them to gain insight into both the impairments and the strengths that
characterize ASD, and to recognize that others share similar challenges. CBT
may be additionally beneficial in terms of increasing specific skills, greater
understanding and insight, and minimizing dropout. Future studies on treatment
of comorbid psychiatric symptoms in ASD should include larger samples to
differentiate between adults with specific psychiatric problems in order to
more effectively assess treatment effects.

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